Respiratory Focus Points for Test:
 Review Lets talk about ABGs handout
 Review Table 19-1 Structures of the Larynx
-Example knowing which structure is responsible for vocal
sounds versus which one is a flap that covers the opening
of the larynx during swallowing.
-Obtaining a proper physical assessment on clients with
respiratory disorders. Looking for finger clubbing-which is
popular in clients with lung dx, ie., lung cancer.
-When inspecting nasal cavity, you look for signs of injury,
inflammation, symmetry, and lesions for all of this can
interfer with gas exchange and how much oxygen your
client is getting in.
 Aspiration is a serious respiratory condition may occur
after procedures, medical condition, or if patient have
trouble swallowing. This is when the epiglottis does not
close properly and food or drinks enter the lungs. Patient’s
are at risk of developing pneumonia-very serious for our
elderly patients.
 Different types of wheezes
-Adventitious breath sounds or abnormal breath sounds are
characterized by crackles and wheezes
-Crackles, Sibilant wheezes (hissing or whistling), sonorous
(deep, sounds like a snore), friction rub.
 Review Table 19-5 Common Abnormalities of the chest
(Exs: Barrel chest, Scoliosis)
 Problems with Respiratoy Physiology:
-Hypoxia: decreased oxygen in inspired air
-Hypoxemia: decreased oxygen in the blood
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-Hypercapnia: increased carbon dioxide in the blood
-Hypocapnia: decreased carbon dioxide in the blood
Know the Diagnostic Tests (Sputum Collection (to be
collected first thing in the morning before clients eat, they
can swish their mouth with water but do not swallow) if
food is present in the container, must be discarded.
-Bronchoscopy Study: can be used to diagnose, treat, or
evaluate lung dx, nursing implications: patient is to be
abstain (NPO) from foods and drinks for 6 hours before the
bronchoscopy.
- Thoracoscopy- using a scope to examine for abnormal
lung tissue or fluid. Physician can also obtain a biopsy.
Patient is in a side-lying position on unaffected side.
Thoracentesis- a procedure to remove excess fluid or air
that has accumulated in the pleural space. The procedure is
done by inserting a needle in the pleural space to remove
the excess air or fluid. The client is usually in a sitting
position at the side of bed leaning over on a bed-side table.
Pressure dressing must be applied afterwards to prevent air
from re-entering. Xray is done immediately afterwards to
check for complications or pneumothorax
Chest tube may be inserted post procedure for both the
thoracoscopy and thoracentesis. Will discuss chest-tube
management in Chapter 21.
How to care for a patient prior to and after these diagnostic
test.
Chapter 20:
Medical and surgical management of sinusitis and rhinitis
 Drugs on Table 20-1
 Post-op care for a Tonsillectomy and Adenoidectomy
patient
-Protecting the airway; removing excess secretions by
suctioning because it may difficult for this patients to
cough after surgery
-Elevating HOB to 45 degree angle when awake.
-Monitor for signs/symptoms of airway obstruction such as
decreased breath sounds for increased respirations (increase
respiratory effort)
-Clients are instructed to not cough, clear throat, blow nose,
or use a straw in the first few postoperative days.
 Nursing management and teaching for Epistaxis
-How would you instruct client to stop bleeding such as
how many fingers to use
-Clients taking anticoagulants should hold them until
bleeding is controlled.
-If nasal packing is applied, tell client not to remove it
unless seen by MD.
-If client questions how would they be able to breath if
nasal passages are blocked, what will you tell them.
 Managing obstructive sleep apnea
-Clients with OSA snore loudly, with breathing stopping
for at least 10 seconds or even longer-(dangerous)
-Box 20-1 Symptoms of Sleep Apnea
-If not managed patients may be prescribed a CPAP
machine or BIPAP for more serious conditions.
 Know signs of laryngeal cancer
-persistent hoarseness, and/or other changes in voice
quality.
 Know Tracheostomy; Suctioning the client with a
Tracheostomy
 Know the Differences between the types of Oxygen we
discussed: Nasal Cannula, BIPAP, CPAP, etc
Chapter 21:
 Bronchitis vs Pneumonia- I won’t focus on the different
types of pneumonia but the nursing care and medical
management
 Influenza including the Treatment (FluMist) who it is not
recommended for
 TB; The Mantoux Test; additional testing if a patient is
positive;
*remember The Mantoux test is a test to show if the patient
has been exposed to TB it does not diagnose the patient;
they have to go for additional testing (need to know)
TSPOT and Quant. Test; CXRAY.
Treatment of TB; Table 21-1; (INH and Combination
Products drugs (these are the popular ones)
Preventing Atelectasis on Table 21-5
 Recognizing clients with COPD and nursing management
 Asthma and know how to read the Peak Flow meter
Asthma Drugs on Table 21-2
Trauma:
 Flail Chest
 Purpose of thoracic surgery
 Post-op care after thoracic surgery; chest tube management